1.

CASEA 28 year old nulliparous woman presents for evaluation of irregularmenstrual cycles for the past year. Her periods come only every 2 or 3months and she has gone as long as 4 months without a period. Currently,she gives a last menstrual period of 11 weeks ago. She says she hadmenarche at age 13 years and that her cycles have been mostly regular,usually occurring every 30 days, but she would miss a cycle several timesa year. She has never been on hormonal contraception. She does notsmoke, does not drink alcohol, and does not exercise. She is sexuallyactive with single partner and uses condoms for contraception. On reviewof systems, she reports a 30 1b weight gain in the past 18 month, butotherwise has felt fine. On examination, she is noted to be obese, with abody mass index of 30. Her vital signs are otherwise normal. She has finehair growth on her face and a velvety thickening of the skin on her neck.Her general physical examination is normal. A pelvic examination revealsnormal external genitalia, no vaginal or cervical discharge, no cervicalmotion tendernees, and no uterine or adnexal masses.

2. KEYWORD1.2.3.4.5.6.7.8.9.

A 28 yearThe last menstrual period of 11 weeks agoMenarche at age 13 yearsHer cycle have been mostly regularDoes not smoke, does not drink alcohol, and does not execise.Body mass index of 30Fine hair growth on her faceGeneral examination is normalNo vaginal or cervical discharge

3. THEORY

Irregular cycles or irregular periods is an abnormal variation in length of

menstrual cycles in a female. A textbook period happens every 24-29days, but in truth what is regular covers a wide range. Cyclesbetween 23-35 days are very common. A woman may get her periodonly one to four times a year. Or she might have periods that occur 2-3times in a month and involve spotting or extremely heavy flow.Alternatively, she may have heavy episodes of bleeding every 2-3months. Irregular periods are simply what is irregular for you.

4. ANALYSIS3

4.1 Clinical Approach

Menstruation irregularly cycles

4.2 DefinitionIrregular cycles or irregular periods is an abnormal variation in length ofmenstrual cycles in a female. A textbook period happens every 24-29days, but in truth what is regular covers a wide range. Cycles between23-35 days are very common. A woman may get her period only one tofour times a year. Or she might have periods that occur 2-3 times in amonth and involve spotting or extremely heavy flow. Alternatively, she mayhave heavy episodes of bleeding every 2-3 months. Irregular periods aresimply what is irregular for you.For the most part, we dont worry at the clinic about a missed period or twoover the course of a year. More variation than that may indicate to us thebeginning of perimenopause or a disruption of the natural chain ofhormonal events that controls menstruation.

4.3 Etiology

While menstruation is orchestrated by many hormones, progesterone and

estrogen are the primary hormones responsible for irregular periods :-

EstrogenEstrogen is responsible for thickening the uterine lining beforeovulation

ProgesteroneProgesterone is responsible for trigerring the sed of the uterinecontens after ovulation when fertilization hasnt occurred

Health section). Cortisol has a direct impact on the sex hormones

estrogen, progesterone, and DHEA. Eating disorders, dieting, drug use,and reliance on stimulants like caffeine and alcohol are also interpreted bythe body as kinds of stress. Poor nutrition seems to physically change theproteins in the brain so they can no longer send the proper signals fornormal ovulation.

4.4 PatofisiologyEstrogen and progesterone disorder

Disturbed body chemical processes

deficit vit B6

impaired serotonin production

menstruation irregularly cycles

4.5 Period Irregular

A normal menstrual cycle lasts 28 days, plus or minus seven days.Menstrual bleeding is considered irregular if it occurs more frequently thanevery 21 days or lasts longer than 8 days. Missed, early, or late periodsare also considered signs of an irregular cycle.To determine whether your menstruation schedule is irregular, count fromthe last day of your previous period and stop counting on the first day of

your next. Repeat this for three months. If the number of days betweenstopping and starting your period is significantly different each month, youhave an irregular cycle.

4.6 Signs And Symptoms

The primary sign of menstruation is bleeding from the vagina.Additional symptoms include :

Food cravings

Mood swings and irritability

Headache and fatigue

Irregular periods are often one of the first signs that a woman is

approaching menopause. Though the exact symptoms of irregular

periods vary depending on a woman's unique cycle, most women willexperience irregular periods for three to ten years before periods stopcompletely. In fact, only 10% of women reach menopause without anyirregular periods.As

menopause

approaches,

women's

hormones

become

imbalanced, and because the menstrual cycle is entirely dependent

upon hormones, irregular periods often occur. Keep reading to learnmore about irregular periods and their symptoms, common causes, andtreatment options.Irregular periods are essentially characterized by what is irregularfor each individual woman. However, there are specific symptoms that canhelp determine if irregular periods are occurring.

4.7 Common Symptoms

Infrequent/too frequent periods

Abnormal duration of bleeding

Changes in blood flow

Blood clots

Missed periods

Painful cramping

4.8 ClasificationOther types of conditions that can be referred to by "irregularmenstruation" include:

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Metrorrhagia, which generally refers to vaginal bleeding that

occurs between the expected menstrual periods.[4] The distinctionbetween irregular cycle lengths and metrorrhagia is not alwaysclear, and may depend on whether the bleeding is regarded asmarking the menstrual period (favoring the term "irregular cycles")or being separate from it (favoring the term "metrorrhagia").

Oligomenorrhea generally refers to infrequent menstruation, [3]

More strictly, it is menstrual periods occurring at intervals of greaterthan 35 days, with only four to nine periods in a year. [3] Also,menstrual

periods

should

have

been

regularly

established

previously before the development of infrequent flow.[3] and often

(but not always) involves irregular intervals. In contrast to "irregularcycles", the interval between one cycle and the next may still beconsistent, but can still be regarded as "irregular" compared to thecycle length of a female without oligomenorrhea. Still, females witholigomenorrhea often have irregular cycles as well.

Polymenorrhea is the medical term for cycles with intervals of 21

days or fewer. This can be regarded as the opposite ofoligomenorrhea.

4.9 ComplicationsFor most women, an irregular period is nothing to be worried about; themajority of women will eventually develop a regular cycle with regularperiods. Sometimes though, underlying complications can be the cause of

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these period problems. If you are noticing particularly irregular periods, or

have gone a year or more with missed periods, see your health careprofessional. If you experience extreme cramping, heavy period bleeding,dizziness, nausea, or fainting you should also visit with your health careprovider.

4.10 Medical treatment

Treatment of irregular periods depends on the cause and your desire tohave children in the future. Irregular periods can be caused by manydifferent things. Changes in your body's level of the hormones estrogen12

and progesterone can disrupt the normal pattern of your period. That'swhy young girls going through puberty and women approachingmenopause commonly have irregular periods.Other common causes of irregular periods include:

Having an intrauterine device (IUD)

Changing birth control pills or using certain medications

Excessive exercise

Polycystic ovary disease (PCOS)

Pregnancy or breastfeeding

Severe scarring (adhesions) of the lining of the uterus, a condition

known as Asherman syndrome

Stress

Overactive thyroid or hyperthyroidism

Thickening of or polyps on the uterine lining

Uterine fibroids

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4.11 How Are Irregular Periods Treated?

Usually, no treatment is needed for irregular periods caused by pubertyand menopause unless they are excessive or bothersome. It is alsonormal for your period to stop when you are pregnant.Treatments for irregular periods due to other causes may include:

Correcting or treating underlying disease

Changing your type of birth control

Lifestyle changes, including weight loss

Hormone therapy

Surgery

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4.12 Prevention and Treatment of Irregular Periods

If stress is a possible culprit in your irregular cycle, try stress

management techniques, such as meditation, yoga, tai chi,visualization, and biofeedback. Avoid over-exercising and try not todiet excessively, as doing so can interfere with your menstrualcycle.

Oral contraceptive pills may be prescribed to get your period back

on track. But if youd rather travel the natural treatment road,consider black cohosh. This medicinal herb is sometimes used formenstrual

irregularities and

premenstrual

syndrome,

though

rigorous scientific studies havent verified these properties. Black

cohash should not be used if you have any symptoms of or a pasthistory of liver disease.

You may have heard that completely darkening your room at nightwill help regulate menstrual cycles but whether it really works isunknown.

A couple of irregular periods per year are usually nothing to worry

about. Any more than that, and you should see a doctor to be surean ovulation problem or health condition isnt the cause. However,you might want to rule out pregnancy first. If youve had sexualrelations in the past month, take a home pregnancy test first,advises Autry. If the test is negative, then you can explore other

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options and talk to your doctor about how to get your menstrualcycle back on track.

5.

Conclusion

If you are overweight, weight loss may be all the treatment you need. Asmall amount of weight loss is likely to help balance your hormonesand start up your menstrual cycle and ovulation.

Eat a balanced diet that includes lots of fruits, vegetables, whole

grains, and low-fat dairy products.

Get regular exercise to help you control or lose weight and feel

better.If you smoke, consider quitting. Women who smoke have higher

levels of androgens than women who don't smoke.

For more information, see Home Treatment.Hormone therapyIf weight loss alone doesn't start ovulation (or if you don't need tolose weight), your doctor may have you try a medicine such

as metformin orclomiphene to help you start to ovulate.

If you aren't planning a pregnancy, you can also use hormonetherapy to help control your ovary hormones. To correct menstrualcycle problems, birth control hormones keep your endometrial

lining from building up for too long. This can prevent uterine cancer.Hormone therapy also can help with male-type hair growth andacne. Birth control pills, patches, or vaginal rings are prescribed forhormone therapy. Androgen-lowering spironolactone (Aldactone) is

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often used with combined hormonal birth control. This helps withhair loss, acne, and male-pattern hair growth on the face and body

(hirsutism).You can use other methods to treat acne and remove excess hair.For more information, see Home Treatment.